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Bipolar disorder, also known as manic-depressive illness, is a serious condition that affects about three per cent of the population, said Dr. Sharman Naicker, a Trail psychiatrist.
While the general population will experience ups and downs in life, someone with bipolar disorder will experience extremely severe mood shifts if not taking medication.
“One pole is high (mania) another pole is low, or depression. That’s why it is called bipolar,” Naicker said.
“It can alternate, but most of the time, a person with the disorder functions in the middle and is no different from anyone else. It is only in relapse and depression when they see the world and themselves in a negative way.”
When high, they have unrealistic thoughts or delusions, he added. They become very active; talk a lot, sleep less, and may believe they are God’s messenger and have grandiose or special powers.
“It’s during this phase when they can sometimes harm other people. These episodes usually last a week or two but that’s when they come to the attention of police or doctors.”
When they spiral from this manic phase into the depression phase, they are at risk of becoming suicidal.
“They are only at risk during high or low states and the vast majority don’t do violent acts – no more so than the general population.”
He said a lot of professional people have bipolar disorder – doctors, psychiatrists and lawyers – as well as a lot of famous and remarkable people, past and present.
Some of those include Ludvig von Beethoven, Mark Twain, Vincent Van Gogh, Winston Churchill, and Theodore Roosevelt. And it may surprise many to learn that Jim Carrey, Robert Downey Jr., Ben Stiller, Robin Williams and astronaut Buzz Aldrin are amongst those living with the disease today.
People with bipolar are effected in differing degrees, Naicker explained. Some may go through a cycle two or three times per year, while others may have an episode once in five or even ten years.
There are two types of medication. One is to maintain a normal mental mood state. It also prevents future episodes. When in relapse, they need something to get them out of it. In early phases, they can slip back.
When high or in the manic phase, a different medication is used to bring them down “but we don’t want to bring them down too far (causing depression) – sort of a soft landing.”
Naicker said 90 to 95 per cent of people with bipolar disorder take their medications regularly.
A person experiencing an extreme manic state or in a severe depression may not be capable of seeking help themselves. If a doctor has sufficient evidence to commit a person with a mental illness, a Form 4 of the Mental Health Act allows for involuntary commitment for up to 48 hours.
“To keep them longer requires a form being filled out by a second doctor and that can be for up to 30 days,” Naicker said.
If the patient is still not well, he or she can have their stay extended by another month.
Involuntary detention can be for periods of one month, three months or six months depending on the severity of the case.
A patient who opposes his or her commitment can appeal through a review panel.
“In the 1950s, half the hospital beds in the Western World were occupied by people with mental problems.”
And studies have found that institutionalizing people only exacerbated the problems, Naicker said.
Those who had everything done for them in institutions deteriorated into a state where they could do absolutely nothing for themselves, making them more dependent on the state.
“They found brains of people who are kept unchallenged, actually shrink.
“Many feel it’s government cutbacks (that closed institutions) and to some degree that is true, but at the same time, there is scientific research which supports keeping people with mental problems in the community.”
Naicker indicated that people with bipolar disorder don’t commit crimes any more so then the general population.
A 2009 research poll released earlier this year and reported in the Ottawa Citizen, found four out of 10 Canadians believe people should be convicted of crimes, even if their mental state meant they didn’t know what they were doing.
However, more than three-quarters agreed that it’s important for the courts to consider a defendant’s mental competency; and most agreed a perpetrator’s mental health at the time of the crime should be considered in passing sentence.
